Astragalin Protects against Spinal Cord Ischemia Reperfusion Injury through Attenuating Oxidative Stress-Induced Necroptosis

Spinal cord ischemia/reperfusion (SCI/R) injury is a devastating complication usually occurring after thoracoabdominal aortic surgery. However, it remains unsatisfactory for its intervention by using pharmacological strategies. Oxidative stress is a main pharmacological process involved in SCI/R, which will elicit downstream programmed cell death such as the novel defined necroptosis. Astragalin is a bioactive natural flavonoid with a wide spectrum of pharmacological activities. Herein, we firstly evaluated the effect of astragalin to oxidative stress as well as the possible downstream necroptosis after SCI/R in mice. Our results demonstrated that astragalin improves the ethological score and histopathological deterioration of SCI/R mice. Astragalin mitigates oxidative stress and ameliorates inflammation after SCI/R. Astragalin blocks necroptosis induced by SCI/R. That is, the amelioration of astragalin to the motoneuron injury and histopathological changes. Indicators of oxidative stress, inflammation, and necroptosis after SCI/R were significantly blocked. Summarily, we firstly illustrated the protection of astragalin against SCI/R through its blockage to the necroptosis at downstream of oxidative stress.

Status of cardiovascular surgery in Japan between 2017 and 2018: a report based on the Japan Cardiovascular Surgery Database. 4. Thoracic aortic surgery

Aim We aimed to analyze the current treatment status of thoracic/thoracoabdominal aortic diseases in Japan. Methods Using the Japan Cardiovascular Surgery Database, the number of cases, operative mortality, and major morbidities (stroke, renal failure, pneumonia, paraplegia) of thoracic and thoracoabdominal aortic surgery in 2017 and 2018 were analyzed by surgical site (root-ascending, arch, descending, thoracoabdominal aorta), surgical procedure, and age group. Results The total number of cases was 39,391 (50.1% aortic dissections, 49.9% non-dissections). The number of cases was highest in patients aged in their 70s. In elderly patients, the rates of root replacement (particularly valve-sparing procedures) in the root-ascending aorta and open-chest surgery in the arch and the descending and thoracoabdominal aorta were decreased. The outcome by procedure analysis showed the lowest mortality and morbidity rates for valve-sparing in the root-ascending region, and lower mortality and morbidity (cerebral infarction, renal failure, pneumonia) in non-open-chest procedures (thoracic endovascular aortic repair with/without branch reconstruction) than in open-chest procedures in the arch, descending, and thoracoabdominal regions. With regards to age, operative mortality in patients aged 80 years or older was significantly higher than in those under 80 years of age for all surgical procedures in the root-ascending, arch, and descending regions. Conclusions Thoracic and thoracoabdominal aortic surgery in Japan was most commonly performed in elderly patients in their 70s, with a good overall mortality rate of 5.3%. Mortality and postoperative morbidity rates in patients aged 80 years or older were still high. In the future, further improvements in surgical outcomes are needed.

A sebészi gerincvelő ischemia és reperfusio hatása a specifikus átáramlásra és a neurológiai következményekre

Összefoglaló. A thoracoabdominalis aorta kirekesztése a gerincvelő keringésének csökkenését okozza. Az ischemia klinikailag paraparesis, paraplegia formájában jelenik meg. Ez elsősorban nyitott műtétek során jelent aligha kiszámítható szövődményt, de a modern endovascularis technikák sem oldották meg teljes mértékben ennek biztonságos kivédését – bár arányát jelentősen mérsékelték. A javuló eredmények számos tényezőre vezethetők vissza, mint a keringés kirekesztési idejének csökkentése, a gerincvelő-funkció és metabolismus ellenőrzése. Mesterséges keringésjavító direkt és indirekt eljárások, liquor drainage, hűtés mellett a collateralis keringés javítását szolgáló prekondicionáló módszerek kerültek bevezetésre. Kísérletes munkánkban 25–30 kg testsúlyú kutyákon vizsgáltuk – más paraméterek mellett – a distalis perfusio növelésének, a liquornyomás csökkentésének, illetve ezek kombinációjának protektív hatását egyórás thoracoabdominalis aortakirekesztés során. Dolgozatunkban a kísérleti állataink neurológiai végállapotát a keringési paraméterek és szöveti perfusio és a reperfusio változásainak összefüggésein keresztül tárgyaljuk. Megállapítottuk, hogy distalis gerincvelő reperfusiós hyperaemiája szorosan összefügg a neurológiai károsodás mértékével. Summary. Clamping of the thoracoabdominal aorta reduces perfusion of the spinal cord significantly, which clinically may present as paraparesis or paraplegia – devastating and unpredictable complications of open thoracoabdominal aortic surgery. Introduction of monitoring of evoked potentials and/or biochemical markers, methods increasing distal arterial pressure, indirect procedures enhancing residual flow (like liquor drainage), drugs, and use of hypothermia contributed to achieve better outcome. Preconditioning of spinal cord circulation is also a promising method. New endovascular techniques for thoracoabdominal aortic aneurysms and dissections reduced surgical trauma significantly. Despite all these progressions spinal cord ischemic damage is still a significant risk. To address this problem we carried out an experimental work using a canine model focusing on the protective effect of distal arterial perfusion, spinal fluid drainage, and their combination in a one hour setting of thoracoabdominal aortic clamping. In this paper we publish our data of circulatory and specific perfusion parameters of the spinal cord during and after declamping in correlation of final neurologic outcome.